CH 29 Management of patients with complications from heart disease Flashcards
preload, afterload, and contractility
factors affecting stroke volume (SV)
the amount of blood presented to the ventricle just before systole
preload
the amount of resistance to the ejection of blood from the ventricle.
- inversely related to SV
- determined by the diameter and distensibility of the great vessels(aorta and pulmonary artery) and the opening and competence of the SL valves (pulmonic and aortic valves)
afterload
the force of contraction, is related to the status of the myocardium.
-Catacholemines can cause increase contractility and SV
contractility
the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients
HF
- Alteration in ventricular contraction which is characterized by a weakened heart muscle
- Ejection fracture less than 40
systolic HF
less common type of HF
- characterized by a stiff and noncompliant heart muscle, making it difficult for the ventricle to fill
- Ef is normal
diastolic HF
normal range 55%-65% of the ventricular volume
Ejection Fracture
tries to compensate for HF by released epinephrine and norepinephrine to increase HR and contractility and support the failing myocardium, but actually has negative effects
sympathetic nervous system
- left ventricle cannot effectively pump
- symptoms include an S3 sound may be heard, dyspnea, orthopnea ,PND paroxysmal nocturnal dyspnea, dry and non productive cough, can lead to frothy sputum, pulmonary edema, crackles, oliguria.
left sided- HF
- right ventricle fails, congestion in the peripheral tissues and the viscera predominates.
- symptoms include JVD, edema, ascites, anorexia, nausea, weakness, weight gain, hepatomegaly and tenderness of RUQ
right sided-HF
test usually performed to confirm the diagnosis of HF, identify the the underlying cause and measure the Ejection fracture(help to determine the severity of HF)
Patient will lay on left side during procedure.
echocardiogram
play a pivotal role in management of HF.
-Relieve signs and symptoms of HF and significantly decrease morbidity and mortality.
ACE inhibitors
this medication is contraindicated in people with systolic HF
but may be used in diastolic HF.
CCB’s
lessening dyspnea, and orthopnea, decrease in crackles, relief of peripheral edema, weight loss, and increased activity tolerance
signs that digoxin therapy is effective
used in patients whose HF does not improve with standard therapy. It involves the use of a biventricular pacemaker to treat electrical conduction defects.
CRT Cardiac resynchronization therapy
increased systolic BP, increased ventricular wall thickness, and increased myocardial fibrosis.
- May present with atypical signs and symptoms
- Decreased renal function
HF in elderly patients
procedure done to assess for HF. The patient is asked to breathe normally while manual pressure is applied over the RUQ for 30-60 secs. If neck vein distention increases more than 1cm the finding is positive.
hepatojugular reflex
urine output less than 500mL/ 24 hr.
oliguria
urine output less than 50mL/ 24 hr
anuria
-Begin with a warm up activity
-avoid extreme weather hot or cold
-ensure you are able to talk during physical activity; if not decrease intensity
-wait 2 hours after eating
-stop if SOB, pain or dizziness occurs
-End with a cool down exercise
Some patients may need to limit physical act. to 3-5 mins.
safety guidelines for physical activity
option for patients with severe fluid overload. A double lumen catheter is used and the patients blood is circulated through a small bedside machine. Liters of excess fluid and plasma are slowly removed.
ultrafiltration
- Position patient upright with legs dangling over the bed(ideal)
- Oxygen
- Morphine
- Diuretics
- NTG
management of pulmonary edema
occurs when decreased CO leads to inadequate tissue perfusion and initiation of the shock syndrome.
- may follow an MI
- May occur as a result of end-stage HF, cardiac tamponade, PE, CM(cardiomyopathy), and dysrhythmias
Cardiogenic shock
